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Disorders of the Spinal Cord

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… Fistulography can be used to determine communication with the spinal canal. CSF analysis can identify meningitis. Myelography identifies communication with CSF or compression of the spinal cord. MRI defines the extent of the sinus and secondary compression of the spinal cord. … Clinical Signs Compression of the cord or spinal nerves from osteophytic projections into the spinal canal is rare. Rarely, compression of neural tissue may result in a transverse myelopathy or neuropathy. …

Comparison of vertebroplasty using directional versus straight needle.

BACKGROUND: Percutaneous vertebroplasty is a minimally invasive procedure that can be performed to treat pain and immobility associated with vertebral compression fractures. Previous studies have shown that a single injection can achieve adequate fill across the midline of the vertebral body. PURPOSE: To compare the radiological outcomes of using a novel steerable needle with using a conventional, straight needle in unipedicular vertebroplasty. MATERIAL AND METHODS: Data were collected from 19 patients who were operated at our institute between 1 September 2010 and 31 March 2011. Outcomes we

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… Cement leakage can occur into the epidural veins, discs, intervertebral foramen, perivertebral soft tissues, and spinal canal. There was no statistically significant difference in the incidence of cement leakage between the directional and straight needle group ( P value = 0.65). … There was no cement leakage into the spinal canal in any of the 19 cases which is a very rare complication. Tanigawa et al. only reported cement leakage into the spinal canal in two out of 300 vertebrae that were treated with vertebroplasty ( 15 ). …

Craniovertebral Junction Instability after Oncological Resection: A Narrative Review.

The craniovertebral junction (CVJ) is a complex transition area between the skull and cervical spine. Pathologies such as chordoma, chondrosarcoma and aneurysmal bone cysts may be encountered in this anatomical area and may predispose individuals to joint instability. An adequate clinical and radiological assessment is mandatory to predict any postoperative instability and the need for fixation. There is no common consensus on the need for, timing and setting of craniovertebral fixation techniques after a craniovertebral oncological surgery. The aim of the present review is to summarize the an

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… Because of the large diameter of the spinal canal at the CVJ, symptoms arise only after a tumor has achieved a very large size or through osseous destruction and tumor-induced instability [ 4 ]. … Due to the relatively wide spinal canal at the CVJ, the majority of patients become symptomatic with movement associated pain rather than neurological deficits due to spinal cord compression. …

PKP/PVP combine chemotherapy in the treatment of multiple myeloma patients with vertebral pathological fractures: minimum 3-year follow-up of 108 cases.

BACKGROUND: Multiple myeloma (MM) is a blood system malignant tumor, which often leads to osteolytic bone destruction, and the vertebral column is the primary site of involvement. However, the efficacy and prognosis of percutaneous kyphoplasty/vertebroplasty (PKP/PVP) for simple vertebral pathological fractures in patients with multiple myeloma are not yet unified. The primary objective of this study was to investigate the efficacy and prognosis of PKP/PVP in the treatment of multiple myeloma patients with vertebral pathological fractures. METHODS: A total of 108 patients with MM from Beijing

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… One patient developed lower extremity paralysis after surgery, and MRI revealed that the spinal canal was compressed by a local tumor (Fig. 4 ). … Clinical analysis of 36 multiple myeloma patients with extramedullary plasmacytoma invasion of the spinal canal. Hematol Oncol. 2015;33:75–79. doi: 10.1002/hon.2126. 19. Audat ZA, Hajyousef MH, Fawareh MD, Alawneh KM, Odat MA, Barbarawi MM, Alomari AA, Jahmani RA, Khatatbeh MA, Assmairan MA. …

Management of skeletal metastases: An orthopaedic surgeon's guide.

Skeletal metastasis is a common cause of severe morbidity, reduction in quality of life (QOL) and often early mortality. Its prevalence is rising due to a higher rate of diagnosis, better systemic treatment, longer lives with the disease and higher disease burden rate. As people with cancer live longer and with rising sensitivity of body imaging and surveillance, the incidence of pathological fracture, metastatic epidural cord compression is rising and constitutes a challenge for the orthopedic surgeon to maintain their QOL. Metastatic disease is no longer a death sentence condemning patients

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… Radiofrequency ablation of spinal tumors: Temperature distribution in the spinal canal. AJR Am J Roentgenol. 2000;175:1263–6. doi: 10.2214/ajr.175.5.1751263. 46. Goetz MP, Callstrom MR, Charboneau JW, Farrell MA, Maus TP, Welch TJ, et al. …

Microwave ablation combined with cementoplasty under real-time temperature monitoring in the treatment of 82 patients with recurrent spinal metastases after radiotherapy.

BackgroundThe spine is the most frequently affected part of the skeletal system to metastatic tumors. External radiotherapy is considered the first-line standard of care for these patients with spine metastases. Recurrent spinal metastases after radiotherapy cannot be treated with further radiotherapy within a short period of time, making treatment difficult. We aimed to evaluate the effectiveness and safety of MWA combined with cementoplasty in the treatment of spinal metastases after radiotherapy under real-time temperature monitoring.MethodsIn this retrospective study, 82 patients with 115

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… While filling the ablation area with PMMA as much as possible, if the PMMA leaked into the spinal canal and intervertebral foramen, the injection was stopped. The mean volume of bone cement per lesion was 5.7 ± 1.9 mL (range, 2–10 mL). … Percutaneous vertebroplasty in patients with spinal canal compromise. AJR Am J Roentgenol. 2004;182(4):947–951. doi: 10.2214/ajr.182.4.1820947. 24. van der Linden E, Kroft L, Dijkstra P. …

Surgery of the tumors of the spine.

Spinal tumors encompass a heterogeneous group of primary and metastatic lesions requiring individualized management strategies based on tumor biology, patient prognosis, and mechanical stability. Decision-making frameworks, such as NOMS, SINS, and Tokuhashi score, provide structured guidance for selecting metastatic patients for surgery and defining individualized treatment strategies. En bloc resection remains the gold standard for selected primary malignant tumors, whereas separation surgery combined with stereotactic radiosurgery represents the cornerstone of modern metastatic spine disease

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… (G) Sagittal CT scan confirming solid fusion between the treated levels and restoration of the spinal canal. … Thermal injury to the spinal cord or nerve roots represents the main limitation, particularly for lesions located within close distance to the spinal canal. …

Incidence of fracture in adjacent levels in patients treated with balloon kyphoplasty: a review of the literature.

The available evidence suggests that the treatment of painful vertebral compression fractures (VCFs) secondary to osteoporosis or multiple myeloma, by cement augmentation with balloon kyphoplasty (BK), is both safe and effective. However, there is uncertainty in the literature concerning the potential of the procedure to influence the risk for adjacent segment fracture. The aim of this article is to review the available peer-reviewed literature, regarding adjacent vertebral body fractures after kyphoplasty augmentation.

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… They are not typically associated with neurological deficit, since the fractures do not extend into the spinal canal nor compress the neural elements. The majority of these fractures are associated with a limited period of pain. … Potential complications of the procedure include: extrusion of the cement the spinal canal and subsequent spinal cord injury, infection, hematoma formation, pulmonary embolus, failure to relieve pain, and fracture of adjacent vertebral bodies. …

The role of cement augmentation with percutaneous vertebroplasty and balloon kyphoplasty for the treatment of vertebral compression fractures in multiple myeloma: a consensus statement from the International Myeloma Working Group (IMWG).

Multiple myeloma (MM) represents approximately 15% of haematological malignancies and most of the patients present with bone involvement. Focal or diffuse spinal osteolysis may result in significant morbidity by causing painful progressive vertebral compression fractures (VCFs) and deformities. Advances in the systemic treatment of myeloma have achieved high response rates and prolonged the survival significantly. Early diagnosis and management of skeletal events contribute to improving the prognosis and quality of life of MM patients. The management of patients with significant pain due to VC

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… MRI and CT scans are crucial to differentiate between a soft tissue myelomatous mass in the spinal canal from bony encroachment. … canal. …

Multifocal intraosseous hemangioma: A case report.

RationaleMultifocal intraosseous hemangioma, which affects multiple body parts, is rare. The selection of appropriate lesion sites for biopsy and effective treatment in multifocal intraosseous hemangioma is challenging. Here, we report a case of multifocal intraosseous hemangioma.Patient concernsA 49-year-old woman was admitted to our department with a chief complaint of aggravated lumber pain for 10 days.DiagnosesRadiographic imaging revealed lesions involving the bilateral ribs, lumbar vertebrae, ilium, pubis, and proximal femur. Open biopsy in the ilium established the pathological diagnosi

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… On magnetic resonance imaging (MRI), the lumbar lesion presented with long T1 and T2 signals and extended into the spinal canal (Fig. 1 ). Figure 1 Images of the third lumbar vertebra. … canal. …

Mechanical Cavity Creation with Curettage and Vacuum Suction (Q-VAC) in Lytic Vertebral Body Lesions with Posterior Wall Dehiscence and Epidural Mass before Cement Augmentation.

Background and Objectives: We describe a novel technique for percutaneous tumor debulking and cavity creation in patients with extensive lytic lesions of the vertebral body including posterior wall dehiscence prior to vertebral augmentation (VA) procedures. The mechanical cavity is created with a combination of curettage and vacuum suction (Q-VAC). Balloon kyphoplasty and vertebral body stenting are used to treat neoplastic vertebral lesions and might reduce the rate of cement leakage, especially in presence of posterior wall dehiscence. However, these techniques could theoretically lead to in

Radiological Diagnosis and Advances in Imaging of Vertebral Compression Fractures.

Vertebral compression fractures (VCFs) affect 1.4 million patients every year, especially among the globally aging population, leading to increased morbidity and mortality. Often characterized with symptoms of sudden onset back pain, decreased vertebral height, progressive kyphosis, and limited mobility, VCFs can significantly impact a patient's quality of life and are a significant public health concern. Imaging modalities in radiology, including radiographs, computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) studies and bone scans, play crucial

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… These fractures may exhibit loss of vertebral height, retropulsion of bony fragments into the spinal canal, and disruption of the posterior ligamentous complex. … Additionally, CT imaging can evaluate retropulsion of bone fragments into the spinal canal ( Figure 5 ). The presence of retropulsed fragments can result in spinal canal compromise and potential compression of the spinal cord or nerve roots. …

Spinal lesions: a comprehensive radiologic overview.

Spinal lesions encompass a diverse range of pathologies, including primary and secondary tumors, infectious processes, vascular malformations, traumatic injuries, and degenerative conditions, each with distinct imaging characteristics crucial for accurate diagnosis and management. Imaging plays vital roles in assessing lesion morphology, anatomical localization, and neurological impact, guiding clinical decision-making and therapeutic planning. This review systematically explores spinal lesions based on their anatomical compartments, highlighting key radiological features and providing a compr

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… with moderate narrowing of the spinal canal. … On T2-WI, a hypointense line surrounding the spinal canal may be seen which indicates bulging of the dura into the spinal canal due to displacement by the epidural hematoma. …

Miscellaneous Spinal Cord Diseases

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Rapid Fire

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Development and definition of a simplified scoring system in patients with multiple myeloma undergoing stem cells transplantation on standard computed tomography: myeloma spine and bone damage score (MSBDS).

BackgroundIn clinical practice, there is the need to optimize imaging usage in MM patients. Accordingly, the aim of this paper was to develop a simple computed tomography (CT) scoring method for MM, able to shorten and simplify the interpretation time with good intra- and inter-reader reliability. This method, named MSBDS (Myeloma Spine and Bone Damage Score) was developed with the final aim to use standard total-body CT in the routine practice of MM centres as a complement of standard evaluations in patients undergoing stem cells transplantation.MethodsWe used a widely accepted consensus form

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… In this case, there was also a possible spinal canal involvement. d ) Lytic lesion > 5 mm (white arrow) at the junctional spine (thoraci spine) with collapse/involvement < 50%, and a small (small white arrow) focal lesion at the right rib cage. … In this case, there is spinal canal involvement. f ) Lytic lesion at the left femoral neck (white arrow). …

The role of percutaneous vertebral augmentation in patients with metastatic breast cancer: Literature review including report of two cases.

Patients with metastatic breast cancer are at high risk for developing vertebral compression fractures due to underlying bone metastases and bone density loss. Vertebral augmentation techniques including percutaneous vertebroplasty and percutaneous balloon kyphoplasty are techniques used to stabilize compression fractures and improve pain. However, rare complications from these interventions have been observed, including spinal cord compression, nerve root compression, venous cement embolism, and pulmonary cement embolism. These complications pose unique potential challenges for patients with

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… A potential serious complication of vertebral augmentation is the leakage of PMMA bone cement into the spinal canal or paravertebral venous plexus, which may lead to spinal compression [ 53 , 54 ]. … MRI of the lumbar spine showed an L2 vertebral body pathologic fracture with approximately 60% height loss, with associated osseous retropulsion, causing moderate spinal canal stenosis and effacement of the left lateral recess. …

Myeloma Spine and Bone Damage Score (MSBDS) on Whole-Body Computed Tomography (WBCT): Multiple Reader Agreement in a Multicenter Reliability Study.

Objective: To assess the reliability of the myeloma spine and bone damage score (MSBDS) across multiple readers with different levels of expertise and from different institutions. Methods: A reliability exercise, including 104 data sets of static images and complete CT examinations of patients affected by multiple myeloma (MM), was performed. A complementary imaging atlas provided detailed examples of the MSBDS scores, including low-risk and high-risk lesions. A total of 15 readers testing the MSBDS were evaluated. ICC estimates and their 95% confidence intervals were calculated based on mean

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… In this case, the MSBDS was 11 with a standard deviation of 5.3 due to difficulties in spinal canal assessment mainly by non-specialists. In these cases, a sub-specialized second reading should be recommended. … In this case, the MSBDS was 5.7 with a standard deviation of 3.3 due to difficulties in spinal canal assessment, bone diameter and extraosseous involvement (asterisks). 4. …

Complications of vertebral augmentation in metastatic spinal fractures: a systematic review of multiple study designs.

BACKGROUND: Vertebral augmentation techniques, including vertebroplasty and kyphoplasty, are widely used to relieve pain and restore spinal stability in patients with metastatic vertebral lesions. Despite their widespread use, the full spectrum and clinical significance of procedure-related complications remain incompletely characterised. This systematic review aims to summarise and characterise all reported complications associated with vertebral augmentation for metastatic thoracolumbar disease. METHODS: A comprehensive search of PubMed/MEDLINE, Scopus, and Web of Science databases was perf

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… Morghen, I et al. [86] 2009 Vertebroplasty Tumour extrusion into the spinal canal MRI showed extrusion of tumour tissue into spinal canal without neurological deficit 24 h Radiotherapy Pain resolution 13. … Morghen, I et al. [86] | 2009 | Vertebroplasty | Tumour extrusion into the spinal canal MRI showed extrusion of tumour tissue into spinal canal without neurological deficit | 24 h | Radiotherapy Pain resolution 13. …

Holistic Approach to the Diagnosis and Treatment of Patients with Tumor Metastases to the Spine.

The treatment of neoplastic spine metastases requires multi-faceted assessment and an interdisciplinary approach to patients. The metastases do not show specific symptoms but are often the first confirmation of the presence of a primary tumor in a patient. The diagnostic process includes imaging and invasive procedures, e.g., biopsy. It is essential to qualify the patient for an appropriate treatment using dedicated scales. Decompression of the spinal cord is a critical issue to save or restore neurological function in a patient with spine metastases. Surgical treatment ought to meet three cri

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… The cause of damage to the nerve roots is their compression by fragments of a pathologically fractured vertebra or the neoplastic mass present in the spinal canal and intervertebral foramina. … It takes into account a patient’s immune condition and damage to the spine and nervous elements of the spinal canal. …